Critical care nurses' role in the decision-making process of withdrawal of life-sustaining treatment: A qualitative systematic review

J Clin Nurs. 2023 Sep;32(17-18):6012-6027. doi: 10.1111/jocn.16728. Epub 2023 Apr 21.

Abstract

Aim: To synthesise the qualitative evidence regarding the role of critical care nurses in the decision-making process of withdrawing life-sustaining treatment in critically ill adults.

Design: Qualitative systematic review.

Review methods: This qualitative systematic review employed the guidelines of Bettany-Saltikov and McSherry. The review was reported according to the ENTREQ checklist. Pairs of authors independently assessed eligibility, appraised methodological quality and extracted data. Data were synthesised using thematic synthesis.

Data sources: CINAHL, MEDLINE and EMBASE were searched for studies published between January 2001 and November 2021.

Results: Twenty-three studies were included. Three analytical themes were synthesised: performing ethical decision-making to safeguard patients' needs rights, and wishes; tailoring a supporting role to guide the family's decision-making process; and taking on the role of the middleman by performing coordination.

Conclusion: The role of the critical care nurses in the decision-making process in withdrawal of life-sustaining treatment requires experience and the development of the clinical perspective of critical care nurses.

Implications for the profession and/or patient care: Enhanced knowledge of the decision-making process of withdrawing life-sustaining treatment can prepare critical care nurses to be more equipped to master this role and enhance their ability to handle the emotional and moral stress associated with this part of the critical care unit.

Impact: The literature reveals the complex and challenging role of critical care nurses during the decision-making process of withdrawing life-sustaining treatment. Critical care nurses perform ethical decision-making to safeguard patients' concerns, guide the family's decision-making process and take on the role of the middleman. The findings have implications for critical nurses working in critical care units in hospitals and for educators and students in training in critical care nursing.

Patient or public contribution: No patient or public contribution was included.

Keywords: critical care nurses; critical care unit; decision-making; systematic review; withdrawal of life-sustaining treatment.

Publication types

  • Systematic Review
  • Review

MeSH terms

  • Adult
  • Critical Care
  • Humans
  • Intensive Care Units
  • Nurse's Role*
  • Qualitative Research
  • Terminal Care* / psychology